A Narrative Review of the Applications of Ex-vivo Human Liver Perfusion

Abstract

Ex-vivo perfusion describes the extra-corporeal delivery of fluid to an organ or tissue. Although it has been widely studied in the context of organ preservation and transplantation, it has also proven to be an invaluable tool in the development of novel models for translational pre-clinical research. Here, we review the literature reporting ex-vivo human liver perfusion experiments to further understand current perfusion techniques and protocols together with their applications. A computerised search was made of Ovid, MEDLINE, and Embase using the search words "ex-vivo liver or hepatic perfusion". All relevant studies in English describing experiments using ex-vivo perfusion of human livers between 2016 and 2021, inclusive, were included. Of 21 reviewed studies, 19 used ex-vivo human liver perfusion in the context of allogeneic liver transplantation. The quality and size of the studies varied considerably. Human liver perfusion was almost exclusively limited to whole organs and "split" livers, although one study did describe the successful perfusion of tissue sections following a partial hepatectomy. This review of recent literature involving exvivo human liver perfusion demonstrates that the technique is not limited to whole liver perfusion. Splitliver perfusion is extremely valuable allowing one lobe to act as a control and increasing the number available for research. This review also highlights the present lack of any reports of segmental liver perfusion. The discarded donor liver is a scarce resource, and the successful use of segmental perfusion has the potential to expand the available experimental models to facilitate pre-clinical experimentation.

Experimental Models for Studying Structural and Functional State of the Pathological Liver (Review)

“…Thus, the perfusion liver system is an effective model reflecting the diversity of the individual human response to the action of the preparation, and gives a more complete notion about the mechanisms of paracetamol pathogenesis. However, inability to maintain the viability of liver specimens for a long time prevents using the model for a long-term testing of the preparation effect [ 156 ].…”

Development of a Novel Ex Vivo Porcine Hepatic Segmental Perfusion Proof-of-Concept Model Towards More Ethical Translational Research

“…To our knowledge, there are currently no reported studies describing ex vivo perfusion of an isolated hepatic segment [ 6 ]. The development of a novel ex vivo human liver segmental perfusion model would address the three principles of replacement, reduction and refinement and provide a versatile model for a wide range of pre-clinical studies [ 3 ].…”